Background: Two-stage exchange arthroplasty remains the standard treatment of infection at the site of a total knee arthroplasty. The clinical and functional outcomes associated with the use of an articulating antibiotic spacer for two-stage revision for infection are not well established. We conducted a retrospective study to evaluate the outcomes associated with the use of the PROSTALAC articulating spacer between the first and second stages.
Methods: Fifty-eight patients underwent two-stage revision total knee arthroplasty for infection between January 1997 and December 1999. Of these, fifty-four were alive at the time of follow-up and forty-seven were available for inclusion in the present retrospective study. In all patients, a prosthesis of antibiotic-loaded acrylic cement (the PROSTALAC system) was implanted during the first stage after débridement. The amount of osteolysis that occurred between the stages and the range of motion of the knee joint were measured. After two years of follow-up, outcomes were assessed with use of the WOMAC, Oxford-12, and SF-12 instruments as well as a satisfaction questionnaire.
Results: At a minimum of two years (average, forty-one months) after revision arthroplasty, two patients (4%) had had a recurrence of infection. The amount of bone loss was unchanged between stages, and the range of movement of the knee improved from 78.2° before the first stage to 87.1° at two years. The average normalized WOMAC function and pain scores were 68.9 and 77.1, respectively; the average Oxford-12 score was 67.3; the average SF-12 mental and physical scores were 53.7 and 41.2, respectively; and the average satisfaction score was 71.7.
Conclusion: A revision operation for infection at the site of a total knee replacement with use of an articulating spacer was associated with reasonable function and satisfaction scores. These findings may be related to the articulating features of the PROSTALAC system, which permits full active movement of the knee in the early postoperative period.
Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.
R.M. Dominic Meek, MBChB, MD, FRCS(Tr and Orth); 12A Sydehham Road, Dowanhill, Glasgow G12 9NP, Scotland
Bassam A. Masri, MD, FRCSC; David Dunlop, MBChB, FRCS(Tr and Orth); Donald S. Garbuz, MD, MHSc, FRCSC; Nelson V. Greidanus, MD, MPh, FRCSC; Robert McGraw, MD, FRCSC; Clive P. Duncan, MD, FRCSC; Division of Lower Limb Reconstruction and Musculoskeletal Oncology, Department of Orthopaedics, Vancouver Hospital and Health Sciences Centre, The University of British Columbia, 910 West Tenth Avenue, Third Floor, Vancouver, BC V5Z 4E1, Canada. E-mail address for B.A. Masri: email@example.com